Dr Derek Proctor Richardson, MD is a medicare enrolled "Dermatology" physician in Glens Falls, New York. He went to Saint Louis University School Of Medicine and graduated in 1970 and has 54 years of diverse experience with area of expertise as Dermatology. He is a member of the group practice Gateway Dermatology, P.c. and his current practice location is
Four Irongate Center, Glens Falls, New York. You can reach out to his office (for appointments etc.) via phone at
(518) 798-1778.
Dr Derek Proctor Richardson is licensed to practice in New York (license number 114475) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1568552719.
Physician's Profile
| Full Name | Dr Derek Proctor Richardson |
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| Gender | Male |
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| Speciality | Dermatology |
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| Experience | 54 Years |
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| Location | Four Irongate Center, Glens Falls, New York |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Derek Proctor Richardson attended and graduated from Saint Louis University School Of Medicine in 1970
NPI Data:
- NPI Number: 1568552719
- Provider Enumeration Date: 10/16/2006
- Last Update Date: 10/28/2022
Medicare PECOS Information:
- PECOS PAC ID: 8325235120
- Enrollment ID: I20101206001075
Medical Identifiers
Medical identifiers for Dr Derek Proctor Richardson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568552719 | NPI | - | NPPES |
| 000407083001 | Other | NY | BLUE SHIELD |
| 040426007626 | Other | NY | FIDELIS |
| 07121 | Other | NY | MVP HEALTH PLAN |
| 10001709 | Other | NY | CDPHP |
| 141622071 | Other | | TAX ID # |
| 48F2111 | Other | NY | BLUE CROSS |
| 00352149 | Medicaid | NY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207N00000X | Dermatology | 114475 (New York) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Gateway Dermatology, P.c. | 2163518481 | 6 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Derek Proctor Richardson allows following entities to bill medicare on his behalf.
| Entity Name | Gateway Dermatology, P.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1851599047
PECOS PAC ID: 2163518481
Enrollment ID: O20071018000327 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Derek Proctor Richardson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Derek Proctor Richardson, MD
Four Irongate Center,
Glens Falls, NY 12801
Ph: (518) 798-1778 | Dr Derek Proctor Richardson, MD
Four Irongate Center,
Glens Falls, NY 12801
Ph: (518) 798-1778 |
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